An active 79 year old male with a cold and cough (primarily runny nose and cough), taking warfarin, atorvastatin, amlodipine, benazepril and bisoprolol. Guaifenesin for the cough, acetaminophen for any accompanying pain and Benadryl for the runny nose would seem safe choices. For those retail pharmacists out there, are there any combination products, or combination of individual products, you would recommend? Thanks.
OTC Cold and Cough?
- Thread starter cjb56
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Benadryl is NOT recommended for older individuals due to high fall risk. Would recommend Dayquil. Guaifenesin only if cough is productive...and honestly it's not got great data behind it.
Thanks. I was thinking Benadryl at night, to stop the runny nose while trying to sleep, but yes, there could still be a risk when getting out of bed in the middle of the night. Thanks.
The question becomes - why can't he sleep? Is it cough? Dayquil before bed - it won't keep him up. Is it nasal congestion? Will still work...but I favor nasal sprays for older individuals due to NO systemic absorption. Give a few sprays up the nose and he'll sleep like a dream. Taking Benadryl to sleep can work but honestly, unless there is no CAUSE for the lack of sleep or it is something that cannot be remedied OTC (e.g. hot flashes) then we should be addressing the root cause of the insomnia.
I think he is sleeping okay. Dayquil has DM for the cough, which I thought might not be a good choice.
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to be honest....this is no "perfect" drug to give this guy
with everything out there, u have to weigh the risk vs. benefit
look for something with an antihistamine and cough suppressant or expectorant
just as long as you avoid an NSAID and PSE 👍
with everything out there, u have to weigh the risk vs. benefit
look for something with an antihistamine and cough suppressant or expectorant
just as long as you avoid an NSAID and PSE 👍
Thanks. As a student, I still sometimes get myself lost in the tangle of possible adverse reactions and drug interactions, and I don't yet have the confidence to distinguish some of the theoretical adverse effects from the absolute adverse effects. And yes, I still get caught looking for the perfect wonder drug for a given condition.
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once u begin working in the "real world"
people will bring up two products and ask "which one is better for a cold"......
this is where u will ask their sx's, etc.....u give them your honest choice and they will end up buying the other
people will bring up two products and ask "which one is better for a cold"......
this is where u will ask their sx's, etc.....u give them your honest choice and they will end up buying the other
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Hahaha so true.
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My favorite is when the two bottles have the same drugs.
Sometimes I do tell them the truth that they don't really help. My preferred medications for a cold are pseudoephedrine and anti-histamine. They also don't like it when I tell them the best way to treat the flu is to get tylenol/ibuprofen for the fever, rest, and stay hydrated.
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People want an "all-in-one" medicine that says for "cold's & flu's" on the label..... I almost never recommend such a product. Many people don't understand that there is nothing magical in the "cold's & flu's" products that actually treats cold's & flu's--they don't understand that these products treat symptoms. Most of the the time an "all-in-one" medicine gives the patient medicines for symptoms that they are don't have (there by unnecessary risk of side effects), or even worse, the medicine may worsen their symptoms or their other health conditions. So, I almost always recommend piece meal products to people.....which people don't like & often ignore my advice, but oh well. I'm not going to pretend that Nyquil will do anything to help them cough up the gunk in their lungs, or that Coricidin will do anything for their nasal congestion, or that Theraflu is the best choice when their only symptom is body aches & felling pukey. Almost all of the combination products have dextromethorphan--which, much of the time people really don't need because if they have a cough its from nasal drainage or because they are coughing up junk. Almost none of the combination products have guaifenesin--which often suits the pt's symptoms better than dextromethorphan. I have on rare occasions recommended a combo product when they pt had all the symptoms, that the ingredients of the combo product would treat, but this pretty rare.
OP: I would most likely make the same recommendations that you made.
My general recommendations:
If the person is suffering from a runny nose & has no health conditions that would be worsened, Benadryl is the cheapest, most effective way to dry it up. (I've heard other pharmacists & doctors recommend Zyrtec, or worse Claritin--these anti-histimines have very little drying action, which is why they are nice for people who take them chronically for allergies and don't want all the 1st generation antihistamine side-effects, but they aren't going to help dry up mucous for someone with a cold.)
Sudafed for nasal congestion, assuming no HBP or other health conditions that would be worsened by this (if so, then I recommend Ocean nasal spray or a neti-pot)
Mucinex or plain robitussin to help them cough up gunk....yeah, I'm aware of the data showing it isn't all that effective, but its not like there are other OTC options. I also tell them to push water or other fluids.
Delsym or Robitussin DM for a mixed cough or a dry cough. Sugar-free versions if they are diabetic (although realistically in the real world, the amount of sugar in the cough syrups is probably not going to have that big of effect for most people with diabetes.)
Vick Vapor rub is an option also for nose/chest congestion.
Tylenol, or if no other contraindications Motrin/Advil for pain/body aches.
Chloraseptic for a sore throat.
Nauzene for pukiness.
Imodium for severe diarrhea, if it seems likely to be caused by a virus and not by food poisoning.
Of course, there is no reason not to recommend whatever generic version of all of the above, that your store is selling. Almost all of the combination products have dextromethorphan--which, much of the time people really don't need because if they have a cough its from nasal drainage or because they are coughing up junk. Almost none of the combination products have guaifenesin--which often suits the pt's symptoms better than dextromethorphan. I have on rare occasions recommended a combo product when they pt had all the symptoms, that the ingredients of the combo product would treat, but this pretty rare.
OP: I would most likely make the same recommendations that you made.
My general recommendations:
If the person is suffering from a runny nose & has no health conditions that would be worsened, Benadryl is the cheapest, most effective way to dry it up. (I've heard other pharmacists & doctors recommend Zyrtec, or worse Claritin--these anti-histimines have very little drying action, which is why they are nice for people who take them chronically for allergies and don't want all the 1st generation antihistamine side-effects, but they aren't going to help dry up mucous for someone with a cold.)
Sudafed for nasal congestion, assuming no HBP or other health conditions that would be worsened by this (if so, then I recommend Ocean nasal spray or a neti-pot)
Mucinex or plain robitussin to help them cough up gunk....yeah, I'm aware of the data showing it isn't all that effective, but its not like there are other OTC options. I also tell them to push water or other fluids.
Delsym or Robitussin DM for a mixed cough or a dry cough. Sugar-free versions if they are diabetic (although realistically in the real world, the amount of sugar in the cough syrups is probably not going to have that big of effect for most people with diabetes.)
Vick Vapor rub is an option also for nose/chest congestion.
Tylenol, or if no other contraindications Motrin/Advil for pain/body aches.
Chloraseptic for a sore throat.
Nauzene for pukiness.
Imodium for severe diarrhea, if it seems likely to be caused by a virus and not by food poisoning.
Of course, there is no reason not to recommend whatever generic version of all of the above, that your store is selling. Almost all of the combination products have dextromethorphan--which, much of the time people really don't need because if they have a cough its from nasal drainage or because they are coughing up junk. Almost none of the combination products have guaifenesin--which often suits the pt's symptoms better than dextromethorphan. I have on rare occasions recommended a combo product when they pt had all the symptoms, that the ingredients of the combo product would treat, but this pretty rare.
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